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Clinical Pharmacology and Toxicology the
“medical science of therapeutics and poisoning”


History:
The Division of Clinical Pharmacology at the University of Toronto was created in the 1970’s at the Sunnybrook campus by Dr. Martin Myers, a cardiologist, the Division founding director.  Drs. Frans Leenan (cardiologist), Edward Sellers (internist) and Neil Shear (dermatologist) have been Division Directors until 2003. Currently, Dr. Shinya Ito, (paediatrician) heads both the University Division and the Hospital for Sick Children Division of Clinical Pharmacology and Toxicology. Dr. David Juurlink is the head of the Sunnybrook Division of Clinical Pharmacology. Since the inception of the division, and due to its inherent cross-disciplinary nature, the majority of division members have been cross-appointees of other divisions and departments, but efforts of the committed individuals and groups have always contributed to the division’s strong academic activity. Close collaboration with University of Toronto Faculty of Pharmacy, hospital departments of pharmacy, and University of Toronto Department of Pharmacology also characterize our division’s unique position.

Clinical:
In addition to their primary specialty practice, division members’ clinical activities take place mainly at Sunnybrook Hospital and SickKids. The Sunnybrook Drug Safety Clinic led by Dr. Neil Shear is a collaborative program with members from Clinical Pharmacology, Dermatology, Allergy/Immunology and General Internal Medicine. Pharmacy (drug information) is also an integral part of the clinic. Clinical toxicology, based primarily at the Ontario Poison Centre at SickKids represents one of the most active clinical programs of the division and is directed by Dr. Margaret Thompson. Dr. David Juurlink (Internal Medicine) as well as Drs. Marco Sivilotti (Queen’s, Emergency Medicine) and Prashant Joshi (State University of New York, Pediatrics) provide complementary toxicology expertise to the program. Receiving nearly 75,000 poisoning-related inquiries per year, this program provides 24/7 consultation to the public and health professionals across Ontario. The Motherisk program at SickKids deals with the increasingly multi-disciplinary field of reproductive toxicology. Directed by Dr. Gideon Koren, the program receives approximately 35,000 safety related questions about maternal exposures to drugs, infectious agents and chemicals during pregnancy and lactation. Several physician staff with cross-appointments (including Dr. Irena Nulman and Dr. Shital Gandhi) consult in specialty areas. Trainees from a number of medicine and pediatric training programs rotate these and other clinical areas including Breaking the Cycle, assessment of Fetal Alcohol Syndrome patients and the Drug, Adverse Reactions and Toxicology Clinics. 

Research: (Research of division members primarily appointed to Medicine).
The breadth and impact of Clinical Pharmacology research by the division members is impressive. Mechanisms, diagnosis and clinical management of severe adverse drug reactions have been a research focus of several division members. Dr. Neil Shear, one of the first to define and characterize the in vitro phenotype of patients with drug hypersensitivity, continues playing an important role in the field nationally and internationally. Dr. Paul Oh is active in pharmaco-economics research. Geriatric pharmacology research has been led by Dr. Barbara Liu, who was the 1997 winner of the William B. Abrams Award in Geriatric Clinical Pharmacology from the American Society for Clinical Pharmacology & Therapeutics (ASCPT). Based at Sunnybrook and the Institute for Clinical and Evaluative Sciences (ICES), Dr. David Juurlink continues to be very active and is recognized for his innovative work in pharmaco-epidemiology and drug safety. He was also the 2005 winner of the William B. Abrams Award from the ASCPT and the 2006 Piafsky Young Investigator Award from the Canadian Society for Clinical Pharmacology.  Dr. Paula Harvey, University Health Centre, focuses her research on neurogenic, hormonal and vascular mechanisms of cardiovascular regulation in humans and is published extensively in this area.  

Education:
The Clinical Pharmacology and Toxicology training program, with 3 major sites (Sunnybrook, Toronto Rehabilitation Centre, and SickKids), is one of the largest and most active in Canada and worldwide. Dr. Gideon Koren is the current program director; Dr. David Juurlink is the Sunnybrook-site program director. Until 2005, this Royal College accredited program has accepted residents from 4 entry specialties (i.e., Medicine, Paediatrics, Anesthesia, and Psychiatry). Recently, Emergency Medicine has been added as one of the entry disciplines into the program.  Various clinical/educational rounds are held across the city. On Fridays, the Ontario Poison Centre hosts Clinical Toxicology rounds at Sickkids.  These are well attended and will soon be available on webcast.  These are followed by Motherisk Interdisciplinary Rounds. At Sunnybrook, Clinical Pharmacology Grand Rounds are held every Thursday at noon and the monthly Case-Based rounds moderated by Dr. David Juurlink address a wide range of therapeutic issues and have become very popular, attracting staff and students alike.  Both sites have elective opportunities in toxicology, maternal fetal pharmacology and adult pharmacology respectively with residents and fellows applying from many Ontario and Canadian universities.



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